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Y3(S) - T & O > Hand And Wrist > Flashcards

Hand And Wrist Flashcards

(64 cards)

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1
Q

What are the important components of a FALLS history?

A

Before
During
After

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2
Q

What is important to ask a patient before their fall?

A

Cause of fall
Dizziness
SOB
Chest pain
Giving way
Consciousness

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3
Q

What pathologies may you consider if a patient states they were dizzy before their fall??

A

Postural Hypotension
Arrhythmias
Ear pathology

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4
Q

What is important to ask a patient during their fall?

A

Remain conscious?
Hit head
Involuntarily bite lip or pass urine
How did they land

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5
Q

What is important to ask a patient after their fall?

A

How long on floor
Get up independently?

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6
Q

Why is it important to know whether the patient involuntarily bit their lip or passed urine?

A

Indicates potential seizure

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7
Q

Why is it important to know how long a patient was on the floor for after their fall?

A

Longer = higher chances of rhabdomyolysis which increases the risk of developing an AKI

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8
Q

What is the first step in assessing a patient who has fallen on their wrist?

A

Neurovascular assessment

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9
Q

What do you assess in the vascular assessment of the hand/wrist?

A

Pulses
Temperature
Cap refill
Colour

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10
Q

What are the 2 basic components that you would be assessing in the neurological exam of the wrist?

A

Sensation
Power/motor

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11
Q

How do you assess the median nerve sensation to the hand?

A

Tip of index on palmar aspect

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12
Q

How do you assess the ulnar nerve sensation to the hand?

A

Tip of pinky finger on palmar aspect

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13
Q

How do you assess the radial nerve sensation to the hand?

A

1st webbed space on dorsum of the hand

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14
Q

How do you assess the median nerve motor/power component to the hand?

A

Abduct the thumb against force

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15
Q

How do you assess the ulnar nerve motor/power component to the hand?

A

Abduct fingers against force

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16
Q

How do you assess the radial nerve motor/power component to the hand?

A

Extension of the fingers against force

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17
Q

What are the 4 main types of wrist fractures?

A

Colles
Scaphoid
Bartons
Smiths

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18
Q

How to fractures typically present?

A

Pain
Deformity
Swelling
Reduced ROM
Bruising

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19
Q

What is the most common cause of a Colles fracture?

A

FOOSH

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20
Q

How does a Colles fracture look on X-ray?

A

Dinner fork deformity

Dorsal angulation of the distal fragment with dorsal displacement of the distal fragment

On extra articular fracture of the distal radius

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21
Q

What is the type of analgesia given to a patient with a wrist fracture to allow you to reduce the fracture?

A

Biers block

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22
Q

What is a biers block?

A

Blood pressure cuff put on arm and set to 100mmHg above normal systolic (no brachial pulse should be felt)
Then local injected into vein in the wrist

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23
Q

What is a smiths fracture?

A

Volar angulation of distal fragment and volar displacement of distal fragment

Extra articular fracture of distal radius

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24
Q

What is a Barton’s fracture?

A

Intra articular distal radius fracture with radioulnar dislocation/subluxation

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25
What are the 3 managements of wrist fractures?
Back slab immobilisation Closed reduction + back slab ORIF
26
When would you do a back slab immobilisation for a wrist fracture?
When the fracture is non displaced
27
When would you do a closed reduction and back slab for a wrist fracture?
Fracture is displaced
28
What is a back slab?
Cast with an open side to allow for swelling
29
What are the 2 views required to assess a wrist fracture?
X-ray AP X-ray lateral
30
What are the 2 measurements needed to assess whether a patient needs an ORIF for the wrist?
Volar tilt Radial inclination
31
What view is used to assess voLar tilt?
Lateral view VoLar tilt = LateraL view
32
What view is needed to assess radial inclination?
AP view
33
What is ulnar variance?
When the ulnar can move proximal or distally after a wrist fracture
34
How does negative ulnar variance present following a wrist fracture? Ulnar moved more proximal
Ulnar impingement syndrome
35
How does positive ulnar variance present following a wrist fracture? Ulnar moved more distal
Ulnar impaction syndrome
36
What are some complications of wrist fractures?
Mal union Non union (no bony callus forms) Osteoarthritis Median nerve compression
37
What are the 2 types of forearm fractures?
Monteggia fracture Galeazzi fracture
38
What is a monteggia fracture?
Proximal 1/3 of ulna fracture with radial head dislocation
39
What is a galeazzi fracture?
Distal 1/3 of the radius fracture with dislocation of distal radioulnar joint
40
How do scaphoid fractures present?
Pain in anatomical snuff box Positive scaphoid compression test
41
What is a positive scaphoid compression test?
Press down on the tip of the thumb compresses the scaphoid illiciting pain if fractures
42
What artery supplies the scaphoid?
Dorsal carpal branch of radial artery
43
What is the management for a suspected scaphoid fracture?
X-ray and immobilise even if no fracture visible Re x-ray in 2 weeks
44
What is the management for a suspected scaphoid fracture?
X-ray and immobilise even if no fracture visible Re x-ray in 2 weeks
45
What is the next step after re- xraying the wrist for a potential schaphoid fracture and still no fracture line is visible after 2 weeks?
CT or MRI
46
Why is the scaphoid at a high risk of Avascular necrosis or non union?
Retrograde blood supply
47
Is a fracture of the scaphoid more proximal or distal worse and why?
Proximal Retrograde blood supply
48
Why do you get paraesthesia in the radial 3.5 digits in carpal tunnel and not the palm?
Palmar cutaneous branch supplies the palm and it doesn’t travel through the carpal tunnel Digital cutaneous branch does pass through he carpal tunnel
49
Why can you get Thenar muscle wastage in carpal tunnel syndrome?
The anterior interosseous nerve that is a branch of the median nerve travels through the carpal tunnel
50
What muscle is atrophied if a patient has carpal tunnel syndrome and can’t abduct the thumb?
Abductor pollicis brevis
51
What are the typically management steps for carpal tunnel syndrome?
Splint wrist in extension while sleep Activity modification Corticosteroid injection Surgical decompression
52
What is the alternate name for trigger finger?
Stenosing tenosynovitis
53
How does trigger finger present?
Patients fingers locking or clicking and getting stuck in Flexion and struggle to extend
54
What is the pathophysiology of trigger finger?
Inflammation of the flexor tendons or their sheaths that they run through lead to thickening and fibrous bands forming leading to nodule formation These nodules get caught in the sheath leading to the clicking and locking
55
What are the management steps for trigger finger?
Activity modification NSAIDS Splint in extension Corticosteroid injection Surgical intervention
56
What are the 2 surgical options for trigger finger?
Percutaneous surgical release Open decompression
57
What is cubital tunnel syndrome?
Compression ulnar neuropathy at elbow
58
What is ulnar tunnel syndrome?
Compressive ulnar neuropathy at wrist
59
What is the most common neuropathy associated with a supracondylar fracture of the elbow?
Anterior interosseous nerve neuropathy
60
How would an injury to the anterior interosseous nerve in a supracondylar elbow fracture present?
Weakness or inability to make the ok sign with thumb and index finger
61
What structure is affected with Dupuytrens contracture?
Fascia of palm
62
What is the pathophysiology of Dupuytrens contracture?
Myofibroblasts contract causing plamar thickening Nodules form Fibroblasts follow line of tension causes cords Fibroblasts become abdundant and contract cord
63
What are the symptoms of Dupuytrens contracture?
Nodules Pits Finger Flexion Skin thickening
64
What are some managements for Dupuytrens contracture?
Collagenous injections Radiotherapy Fasciectomy Percutaneous needle fasciotomy or aponeurotomy

Y3(S) - T & O (7 decks)

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